{"patient_id":"P05","encounter_id":"KE-P05","note_id":"KN-P05-1","signed":false,"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":2,"needs_look_kidney":1,"surfaced":[{"source":"kidney","family":"kidney"},{"source":"library","family":"bmi"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00005","replay_hash":"4667ee44fd0b8e91b1e253b0e43d1f276ee818c04b0f6c22456569b891a47a32","measurement_replay_hash":"6c3f29aa78e2bbe9acbb907b45014b336597c847d39d5b18dc44409c16f3d5ec","engine":"kidney-engine 2.0","rules":[{"rule":"ckd_epi_2009@1.0","source":"Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)","url":"https://www.acpjournals.org/doi/10.7326/0003-4819-150-9-200905050-00006"},{"rule":"ckd_epi_2021@1.0","source":"Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)","url":"https://www.kidney.org/ckd-epi-creatinine-equation-2021"},{"rule":"kdigo_aki_2012@1.1","source":"KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)","url":"https://kdigo.org/guidelines/acute-kidney-injury/"},{"rule":"kdigo_ckd_2024@1.1","source":"KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"kidney_compare@1.1","source":"Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update","url":"https://www.cms.gov/medicare/coding-billing/icd-10-codes"},{"rule":"kidney_exclusions@1.0","source":"KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"lab_units@1.1","source":"KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"}],"last_replay":null,"library":{"run_id":"LRUN-00005","encounter_id":"KE-P05","note_id":"KN-P05-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"45d2d6965e14bb29fa0e0fe26a2e3517233cd557e7ec18f1d9bed8a5e03e0353","measurement_replay_hash":"e3b62c7dbf6ee4cb200e9525aad6bfaf3d4b57d49316b8dc68f64122202f26f8","surfaced":[{"family":"bmi","topic":"Body-mass index","direction":"UNDER","status":"needs_look","label":"Needs a look","icon":"●","lead":"","quote":null,"text":"Body-mass index 37.2 kg/m2 on 2026-11-12 09:10 meets the published definition's criteria for the category “35 to below 40 band (class 2)” (cdc_adult_bmi@1.0). The note doesn't mention this.","sentence":"Body-mass index 37.2 kg/m2 on 2026-11-12 09:10 meets the published definition's criteria for the category “35 to below 40 band (class 2)” (cdc_adult_bmi@1.0). The note doesn't mention this.","threshold":"Threshold for this category (cdc_adult_bmi@1.0): body-mass index ≥ 35 kg/m2 and body-mass index < 40 kg/m2.","span":null,"note_mentions":false,"lab_ids":["LM-P05-01"],"definition":"cdc_adult_bmi@1.0","version":"1.0","tier":"measured","values":"body-mass index 37.2 kg/m2 on 2026-11-12 09:10","alternatives":["Another published definition (who_adult_bmi@1.0) gives the category “30 or more band”."],"contested":true,"contested_text":"Published bodies disagree on these thresholds; another definition may give a different answer.","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html","optional_set":null,"cite":{"id":"cdc_adult_bmi@1.0","title":"Adult BMI Categories","body":"Centers for Disease Control and Prevention","edition":"page dated March 19, 2024","year":2024,"url":"https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html","locator":"Adult BMI categories table","quote":"Underweight: Less than 18.5; Healthy Weight: 18.5 to less than 25; Overweight: 25 to less than 30; Obesity: 30 or greater; Class 1 Obesity: 30 to less than 35; Class 2 Obesity: 35 to less than 40; Class 3 Obesity (Severe Obesity): 40 or greater","accessed":"2026-11-14"}}],"more":[{"family":"diabetes","topic":"Glucose and HbA1c","direction":"NOT_ASSESSABLE","status":"not_assessable","label":"Not assessable","icon":"∅","lead":"","quote":null,"text":"Glucose and HbA1c: could not check against ada2026_diabetes@1.0: only one HbA1c or glucose result meets the threshold; the definition needs a second one. Results: HbA1c 6.8 % on 2026-11-12 08:00.","sentence":"Glucose and HbA1c: could not check against ada2026_diabetes@1.0: only one HbA1c or glucose result meets the threshold; the definition needs a second one. Results: HbA1c 6.8 % on 2026-11-12 08:00.","threshold":"Categories that count (ada2026_diabetes@1.0): two results at or above the diagnostic thresholds (number of qualifying results ≥ 2); random glucose 200 mg/dL or more with typical symptoms (random glucose ≥ 200 mg/dL and a recorded clinical item); one result at or above a diagnostic threshold (number of qualifying results ≥ 1).","span":null,"note_mentions":false,"lab_ids":["LM-P05-04"],"definition":"ada2026_diabetes@1.0","version":"1.0","tier":"measured","values":"HbA1c 6.8 % on 2026-11-12 08:00","alternatives":[],"contested":false,"contested_text":"","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","optional_set":null,"cite":{"id":"ada2026_diabetes@1.0","title":"2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026","body":"American Diabetes Association Professional Practice Committee","edition":"2026 (Diabetes Care 2026;49 Suppl 1:S27-S49, doi:10.2337/dc26-S002)","year":2026,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","locator":"Table 2.1 Criteria for the diagnosis of diabetes in nonpregnant individuals","quote":"Table 2.1: A1C ≥6.5% (≥48 mmol/mol); FPG ≥126 mg/dL (≥7.0 mmol/L); 2-h PG ≥200 mg/dL (≥11.1 mmol/L) during OGTT; random plasma glucose ≥200 mg/dL (≥11.1 mmol/L) with classic symptoms of hyperglycemia or hyperglycemic crisis. In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal results from different tests ... or the same test at two different time points.","accessed":"2026-11-14"}},{"family":"prediabetes","topic":"Glucose and HbA1c (intermediate range)","direction":"NONE","status":"agrees","label":"Agrees","icon":"✓","lead":"","quote":null,"text":"HbA1c 6.8 % on 2026-11-12 08:00: in the category “a result in the higher (diagnostic) range” of ada2026_prediabetes@1.0; the note doesn't mention this. Nothing to review.","sentence":"HbA1c 6.8 % on 2026-11-12 08:00: in the category “a result in the higher (diagnostic) range” of ada2026_prediabetes@1.0; the note doesn't mention this. Nothing to review.","threshold":"Categories that count (ada2026_prediabetes@1.0): intermediate range (HbA1c 5.7 to 6.4%, fasting glucose 100 to 125 mg/dL, or 2-hour glucose 140 to 199 mg/dL) (HbA1c ≥ 5.7 % and HbA1c < 6.5 % or fasting glucose ≥ 100 mg/dL and fasting glucose < 126 mg/dL or 2-hour glucose ≥ 140 mg/dL and 2-hour glucose < 200 mg/dL).","span":null,"note_mentions":false,"lab_ids":["LM-P05-04"],"definition":"ada2026_prediabetes@1.0","version":"1.0","tier":"measured","values":"HbA1c 6.8 % on 2026-11-12 08:00","alternatives":[],"contested":true,"contested_text":"Published bodies disagree on these thresholds; another definition may give a different answer.","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","optional_set":null,"cite":{"id":"ada2026_prediabetes@1.0","title":"2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026","body":"American Diabetes Association Professional Practice Committee","edition":"2026 (Diabetes Care 2026;49 Suppl 1:S27-S49)","year":2026,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","locator":"Table 2.2 Criteria defining prediabetes in nonpregnant individuals","quote":"A1C 5.7–6.4% (39–47 mmol/mol); FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG); 2-h PG during 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT)","accessed":"2026-11-14"}}],"n_needs":1,"limit":2,"dismissed":0,"ctcae_on":false,"draft_label":"Draft definition: pending clinical and coding review","dismiss_reasons":{"addressed_elsewhere":"Already addressed elsewhere in the record","not_representative":"Values not representative (for example acute illness or a lab error)","not_relevant":"Not relevant to this visit","definition_not_applicable":"The definition does not apply to this patient","other":"Other (explain)"}},"findings":[{"family":"kidney","topic":"Kidney function over time","status":"needs_look","label":"Needs a look","sentence":"Two kidney results 120 days apart are in the G3b range (filtering rate 43.4 on 2026-07-15 and 40.5 on 2026-11-12); the note doesn't mention kidney function.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":null,"note_mentions":false,"lab_ids":["L-0010","L-0011"]}]}